Improving alcohol and tobacco history taking by junior medical officers.

AIMS: We aimed to determine the effectiveness of individual feedback and group feedback in improving recording, assessment, and management of risky alcohol use and of tobacco smoking by Junior Medical Officers (JMOs). METHOD: Medical records of patients admitted by JMOs were examined for recording of alcohol use, alcohol withdrawal, intervention for alcohol, a consultation with the Drug and Alcohol team, tobacco use, and prescription of nicotine replacement therapy (NRT). In year 1, JMOs from hospital 1 received printed individual feedback on their own and their group's performance, while JMOs at hospital 2 attended a presentation of their group feedback. The following year, they reversed roles. RESULTS: A total of 3025 patient records were examined for 130 JMOs. After individual feedback, the percentage of alcohol histories that were quantified rose significantly, from 69% to 82%. More smokers were detected, and NRT prescribing rates rose significantly. Group feedback showed no change. Logistic regression showed that JMOs were significantly more likely to record an alcohol history if located at the smaller hospital and in first year of hospital practice, if the patient was admitted during business hours, was male, and/or was younger than the median age of 70 years; JMOs were significantly more likely to quantify alcohol consumption after individual feedback, but this had no effect on tobacco history recording. CONCLUSION: Our study suggests that individual feedback on performance with education about desired standards is effective in improving the quality of recording of alcohol histories by Junior Medical Officers.

The influence of alcohol and tobacco use in orthopaedic inpatients on complications of surgery.

INTRODUCTION AND AIMS: Tobacco use and heavy alcohol consumption are associated with increased morbidity and mortality. There is limited research on the correlation between tobacco and risky levels of alcohol use and the possible complications associated with a hospital admission. The underestimation of problem drinking, in particular, has obvious repercussions for the management of patients in hospital. If alcohol-related problems go undetected or unrecorded, treatment may be inadequate or inappropriate. The aims of the project were to assess the prevalence of high-risk alcohol and tobacco use in orthopaedic in-patients and to examine any relationship between alcohol and tobacco use and the number and type of complications, management and length of stay. DESIGN AND METHOD: One hundred and fifty-three consecutive orthopaedic admissions to the Orthopaedic Ward at Lismore Base Hospital were screened using the Drinkcheck questionnaire, which is based on the Alcohol Use Disorders Identification Test (AUDIT), but which also screens for tobacco use. Nursing staff on the ward completed a Complications Evaluation Questionnaire (CEQ). The risk status of the subjects was compared to the number and type of complications, to assess any effects of alcohol and tobacco on post-surgical complications. RESULTS: Significant correlations were found between tobacco use, hazardous and harmful alcohol use and numerous medical complications and behavioural problems. Behavioural problems associated with risky alcohol use included verbal abuse, agitation and sleep disturbances, particularly in men; problems associated with tobacco use included agitation and non-compliance. DISCUSSION AND CONCLUSIONS: Orthopaedic patients who smoke and/or drink heavily prior to surgery may have more non-medical complications than non-smokers and light or non-drinkers. All surgery patients should thus be screened for alcohol and tobacco use and alcohol withdrawal, which may cause other symptoms such as behavioural problems, non-compliance and verbal abuse post-surgery.

Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery.

Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation.

Detection of and intervention for excessive alcohol and tobacco use among adult hospital in-patients.

Early detection and intervention for alcohol problems have been shown to reduce subsequent health consequences. However, the extent to which these practices have been implemented is unclear. The study assessed among hospital in-patients (1) the prevalence of at-risk drinking and smoking, (2) current practice in detection and intervention for at-risk drinking and smoking and (3) self-reported effect of any intervention. A brief self-administered questionnaire was administered to adult in-patients addressing alcohol use [Alcohol Use Disorders Identification Test (AUDIT) questionnaire], smoking and self-reported effect of any recent intervention for drinking or smoking. The participant's smoking status and alcohol use as recorded by medical and nursing staff was compared to self-reports. Of 448 in-patients, 50% (226) participated in the study; 38% (170) were ineligible and 12% (52) refused. Participants were aged 61.3 (+/-18.9) years. A higher number of problem drinkers (11.9% vs. 3.5%, p < 0.0001) and current smokers (17.3% vs. 9.3%, p < 0.0001) were identified by the questionnaire compared to the medical records. Hospital staff quantified smoking more consistently than alcohol (54% vs. 42%, p = 0.02). Of those who recalled an intervention, 19% of drinkers and 27% of smokers said they had stopped drinking or smoking for a period since that intervention. Further improvement is required in the rates of detection and interventions for alcohol use disorders and smoking in the hospital setting.

The effectiveness of a tailored intervention for excessive alcohol consumption prior to elective surgery.

AIM: To assess the effectiveness of a tailored pre-operative intervention for excessive alcohol consumption in reducing post-operative complications and alcohol consumption thereafter. METHODS: Patients scheduled for elective surgery requiring at least overnight hospitalisation were screened for alcohol misuse. Consenting, eligible participants with > or =7 days to surgery at the time of screening were offered an intervention and those with <7 days to surgery were provided usual care. RESULTS: Over a period of 2 years and 10 months, 3139 patients were screened to recruit 136 participants. Baseline analysis revealed a mean age of 53 (+/-15.8) years and a mean consumption of 71 g/day (+/-48.1). The intervention group (n = 45) did not differ significantly from controls (n = 91) in age, consumption, and number of current smokers, but there were significantly more women in the control group. There was no difference between the groups in major or minor complications experienced, or length of stay after controlling for age, gender, and baseline consumption. At 6-month follow-up there was a significant reduction in drinking for the entire study population. CONCLUSION: The study did not demonstrate any beneficial effect of the pre-operative intervention on post-operative complications. The relatively short time to surgery, intervention by a non-member of the surgical team, challenges to recruitment and reduced consumption in the control group may have limited the ability of the study to detect a significant effect of the intervention.

Effectiveness of skills-based training using the Drink-less package to increase family practitioner confidence in intervening for alcohol use disorders.

BACKGROUND: Misuse of alcohol is second only to tobacco as a leading cause of preventable death in Australia. There is an opportunity in family practice to detect problems and intervene with people at risk of alcohol-related harm before complications occur. However, family practitioners (FPs) report low levels of confidence in managing patients with drinking problems. The aim of this study was to determine whether the interactive training session using the 'Drink-less' package led to improvement in FPs' self-reported level of confidence in detecting and providing interventions for risky alcohol consumption. METHOD: FPs in urban and rural New South Wales were invited to training sessions in their local area. An introductory overview preceded a practical skills- based session, using the Drink-less package. Participants completed before and after evaluation forms. RESULTS: While 49% (CI 43-55) of the attending FPs indicated at baseline that they felt confident in identifying at-risk drinkers, this proportion rose to 90% (95% CI: 87-93) post-session, and they also reported increases in confidence from 36% (95% CI: 31-41) to 90% in their ability to advise patients. Urban FPs reported lower levels of confidence than rural FPs, both pre- and post-session. CONCLUSION: Training sessions in the Drink-less intervention resulted in increased self-reported confidence in detection and brief intervention for alcohol problems. Further research is needed to determine the duration of this effect and its influence on practice behaviour.

Do elective surgery patients use the internet to look for information about their condition?

BACKGROUND: As 54% of Australians have access to the internet, it might be expected that people scheduled for surgery would look for information on it. No reported Australian studies have quantified internet use by patients before surgery. METHODS: Patients scheduled for elective surgery in two Sydney teaching hospitals were asked to complete self-administered questionnaires while waiting in preadmission clinics. Detail on sources of information consulted about their condition was requested. A small sample was asked about the sites visited and the self-reported usefulness of the information found. RESULTS: Ten per cent (95% CI: 8.5-11.5) of 1571 patients who participated had searched the internet for information relating to their condition. Logistic regression showed that these patients were significantly more likely to be younger than 60 years (P < 0.001; OR: 3.28; CI: 1.99-5.4), to be employed (P < 0.001; OR: 2.27; CI: 1.52-3.4), and to have a higher level of education (P = 0.001; OR: 1.9; CI: 1.28-2.83). Patients of Hospital 1 were significantly more likely to access the internet for information on their condition than those at Hospital 2 (P = 0.002; OR: 1.85; CI: 1.28-2.7). The most nominated sources of information were friends and relatives (20%) and books or magazines (15%). CONCLUSION: In contrast to anecdote, use of the internet to access information prior to elective surgery appears low. Its absolute use compared with other sources of information is also low. More traditional forms of communication appear to still pay an important role in this setting.